CURRICULUM VITAEMuhammad Riza, dr., Sp.A, M.Kes

RIWAYAT PENDIDIKAN:

• S 1 : FK UNS lulus tahun 2002

• S 2 : FK UNS lulus tahun 2007

• Internship : Emma Children’s Hospital Amsterdam and the VU Medical

Center Amsterdam 1 September – 31 November 2011

• Sp2 : FK UGM Lulus tgl 10 Februari 2016

RIWAYAT PEKERJAAN:

• Dokter Spesialis Anak di RSUD Dr. Moewardi

• Staf Pengajar Bag. IKA UNS/ RSUD Dr. Moewardi Divisi Hematologi-

Onkologi

• KPS PPDS Ilmu Kesehatan Anak FK UNS periode Juni 2015 – Juni 2018

Pengenalan Dini Tanda dan Gejala

Kanker pada Anak

Muhammad Riza, Septin Widiretnani

Bagian Ilmu Kesehatan Anak FK UNS/ RSUD Dr. Moewardi Surakarta

0 200 400 600 800 1000 1200

Demam berdarah dengue

Leukemia Limfoblastik akut

Talasemia

Pneumonia

Leukemia Limfoblastik akut

Talasemia

Diare

Leukemia Limfoblastik akut

Talasemia

2016

2015

2014

0

10

20

30

40

50

60

70

AsiaLink International Conference Clinical Epidemiology and Evidence-Based Medicine in Global Perspective, 2010

Profiles of cancer children in Department of Child Health

Moewardi Hospital between 2005- 2010

0

30

60

90

120

150

180

Profiles of cancer children in Department of Child Health

Moewardi Hospital between 2012- 2016

Pediatric Adult

Etiology Not enviromental Important

enviromental

Screening Minimal or no

impact

Critical

importance

Chemosensitivity Very high limited

Outcome Most patients

cured

Most patients are

incurable

Pediatric VS Adult

Categorisation of diagnostic delay

Why is early diagnosis important?

Sign or symptom Type of cancerCommon conditions in the

differential diagnosis

Fever Leukemia, lymphoma Infection

Vomiting Abdominal mass, brain tumorInfection, gastroesophageal

reflux

Constipation Abdominal mass Poor diet

Cough Mediastinal mass

Upper respiratory infection,

reactive airway disease,

pneumonia

Bone or muscle painLeukemia, bone tumor,

neuroblastoma

Musculoskeletal injury, viral

infection

Signs and Symptoms of Childhood Cancers That Can Mimic These Cancers

Sign or symptom Type of cancerCommon conditions in the

differential diagnosis

Headache Brain tumorTension headache, migraine,

infection

Lymphadenopathy (> 2 cm)Leukemia, lymphoma,

metastatic disease

Lymphadenitis, systemic

infection, collagen vascular

disease

Hematuria Wilms' tumorUrinary tract infection,

glomerulonephritis

Voiding difficulty RhabdomyosarcomaCongenital urinary tract

abnormalities

Signs and Symptoms of Childhood Cancers That Can Mimic These Cancers

Related to bone marrow infiltration

• Fatigue

• Pallor secondary to anemia

• Secondary to thrombocytopenia

• Signs of infection secondary to neutropenia

• Bone pain secondary to marrow hyperplasia.0 5 10 15 20 25 30

Demam

Pucat

Nyeri sendi

Diagnostic criteria for neoplastic fever

• Lack of evidence of infection on:

• physical examination

• laboratory examinations eg sputum smears or cultures, cultures of blood,

urine, stool, bone marrow, spinal fluid, pleural fluid and discharge from

local lesions

• imaging studies eg chest radiograph and CT scans of the head, abdomen,

and pelvis.

• Temperature over 37.8°C at least once each day.

• Duration of fever over two weeks.

• Lack of response of fever to an empiric, adequate antibiotic therapy for at least

seven days.

•Prompt, complete lysis of fever by the naproxen test

* naproxen 375 mg (by mouth) every 12 hours for three days.

Mechanisms of Fever in Cancer Patients

Cytokine release by tumor

•Tumor necrosis factor (TNF) and Interleukins (e.g., IL- 1, 2, 6)

Tumor obstruction of tubular or hollow structure and subsequent infection

• Bronchus: post-obstructive pneumonia

• Eustacian tube: otitis media

• Hepatobiliary system: cholangitis

Hypothalamic metastases (altered thermoregulation)

Medications

• Allergic reaction

• Idiosyncratic reaction

Lymphadenopathy

History

(fever, weight loss, night sweats )

Examination (distribution)

Generalized adenopathy (≥2 )→ systemic disease Localized adenopathy

High risk for malignancy (abnormal CBC, LDH,

bone marrow involvement)– for malignancy

+ for malignancyInfection or other

inflammatory state likely

• Hodgkin disease

• Non-Hodgkin lymphoma

• Leukemia

• Neuroblastoma

• Rhabdomyosarcoma

• Histiocytic disorders

Observation with/ out

antibiotics 2-4 weeks

• Multipel tidak diketahui sebabnya

• KGB supraklavikula atau popliteal

• Gejala sistemik yang bermakna

• Hepatomegali atau splenomegali

• KGB mediastinum membesar

• Anemia atau perdarahan

• Antibiotik → respon negatif

• Ukuran tidak mengecil , bahkan membesar

Curiga Kanker (Limfoma) ?

• Aman

• Dapat membedakan keganasan vs proses reaktif

– Reaktif

• <1cm, normal, oval, hipervaskuler, aliran darah

meningkat

– Kanker

• >1cm, bulat, no echogenic hillus, necrosis (+), low blood

flow, extracapsular spread

• Sensitivitas 95% dan Spesifitas 83%

Peran Ultrasonografi

Symptom When to evaluate Test

Fever Fever lasts longer than 14 days

with no identifiable cause.

CBC with differential

Vomiting Vomiting lasts longer than 7 days

with no identifiable cause.

Abdominal and head CT scans

Vomiting is associated with

headache during sleep.

Head CT scan

Constipation Constipation is prolonged (> 1

month) and does not respond to

conventional measures.

Abdominal and pelvic CT scans

Cough Cough is prolonged (> 2 weeks)

and has no identifiable cause.

Chest radiograph

Bone or muscle pain Pain is prolonged (> 2 weeks) and

has no identifiable cause.

Plain-film radiograph, bone and

CT scans, CBC

When and How to Evaluate Signs and Symptoms for Cancer

Symptom When to evaluate Test

Headache Headache occurs during sleep, is

associated with neurologic signs

and vomiting, or occurs in the

absence of a family history of

migraine.

Head CT scan

Hematuria Evaluate immediately if

hematuria has no identifiable

cause.

Abdominal ultrasound

examination

Voiding difficulty Evaluate immediately if voiding

difficulty has no identifiable

cause.

Abdominal ultrasound

examination

Lymphadenopathy (> 2 cm) Evaluate if lymphadenopathy

does not respond to a 7-day

course of antibiotic.

CBC with differential, lactate

dehydrogenase level

...When and How to Evaluate Signs and Symptoms for Cancer

DRAFT II

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